Overview of recent developmental work in Europe Setting up a coherent set of indicators for the EU A project for the Health Monitoring Programme Euro-reves: Setting up a coherent set of indicators Euro-Reves Washington, February 2002

European Community Health Monitoring Programme The objective is to contribute to the establishment of a Community health monitoring system allowing: to measure health status, trends and determinants through the Community; to facilitate the planning, monitoring and evaluation of Community programmes and actions; to provide Member States with appropriate health information to make comparisons and support national health policies.

The actions and objectives were implemented under three headings: Health Monitoring Programme Establishment of Community health indicators; Development of a Community-wide network sharing health data; Analyses and reporting.

Harmonization at post data collection point (selection subsets of items from instruments common to all surveys). Harmonization at this level produces as many questions as answers. Community health indicators The European Health Monitoring Programme is more ambitious and aims to select and develop a coherent set of health indicators for the EU.

Such a set of indicators has to be built: Maximising world developments may not maximise developments for Europe (WHO aims to include measures for less developed countries). Nevertheless, it is hoped that the work of the European groups in the field of health indicators will contribute to the wider work of the WHO. on the national experience of the European countries on other initiatives, such as World Health Organization developments based on the International Classification of Functioning, Activities, and Health (ICF). on specific European Community needs and public health concerns

Setting up a coherent set of indicators for the EU A project for the Health Monitoring Programme

Euro-REVES The main goal of the Euro-REVES project for the HMP was to select or design instruments to monitor the health status of the European population. The need for truly comparable measures of health across European countries has been increasingly recognised if: Health expectancies are at the heart of the project countries are to be able to learn from each other on national initiatives to improve health, Community-wide initiatives are to be properly evaluated

Total life expectancy, life expectancy without disability and life expectancy without chronic disease (WHO, 1984)

Total survival, survival without disability and survival without chronic disease, France , females

1.to select the health dimensions for health expectancy calculations to fit the European Health Information System. 2.to define specifications for the health measures sought. … and for the future (mainly in collaboration with Eurostat) 3.to assess the best way to collect the data: HIS, HES, registers... 4.to design the required measurement instruments 5.to develop the required quality assessment procedures to assess comparability for future new Member States. Practical goals of Euro-REVES

Underlying concepts of Euro-REVES to cover the whole process of heath deterioration and its different approaches (perception, functional, morbidity) to adopt clear definitions and conceptual framework to apply current and past scientific literature and the opinion of experts to the issues. to recommend a global measure as well as a more detailed one: to both tap the 'problem' in each European country and to explain differences (or similarities). to involve researchers from the different member states

Disease>Impairment>Functional limitation>Disability (Nagi, 1965,1976, 1991) Models of the disablement process Disease>Impairment>Functional limitation>Activity Restriction>Handicap (Wood, 1975) Disease>Impairment>Disability>Handicap (ICIDH, 1980)

Functional limitations and activity restrictions Nagi (1965), Wood (1980), Verbrugge&Jette (1994) Wolinsky FD. et al. Journal of Gerontology: Social Sciences 1991 / Finch M, et al. Journal of American Geriatrics Society 1995 / Fried LP et al. Journal of Gerontology: Medical Sciences 1996 / Ferrucci L et al. Gerontologist 1998 / Harwood et al. International Journal of Epidemiology 1998 / Lawrence et al. Journal of Gerontology: Social Sciences 1998 / Spector et al. Journal of Gerontology: Social Sciences Disease - Impairment - Activity limitation & Restriction of Participation (ICF, 2001) Further developments Environmental approach of disability and the social disadvantage (eg. Canadian stream of research on the disablement process...)

To maximise the approaches to measure health, we identified five main health domains Chronic morbidity Functional limitation Activity restriction Perceived health Mental health Euro-REVES

to plan early interventions (technical aids, reeducation, accurate assistance) to understand how to maintain activity with functional limitations (compensatory strategy) Why distinguishing Functional limitation and activity restriction? Nagi (1965), Wood (1975)... Fonctional Limitations Physical, sensory, cognitive Activity Restrictions DISABILITY Feed, dress, work...

1.Perceived health (global / detailed questions) 2.Chronic morbidity (global / detailed questions) 3.Functional limitations (detailed questions) Physical & Sensory / Cognitive 4.Activity restrictions (global / detailed questions) ADL type, IADL type, other major activities 5.Mental health instrument Research conducted on 11 instruments

Chronic morbidity EuroREVES group: V Egidi, L Frova, R Crialesi (Italia); JM Robine (France); R Gispert (Spain) In collaboration with the EuroHIS network: V Egidi, V Buratta, L Frova (Italia); M Heliövaara (Finland); JM Robine (France); R Gispert (Spain); A de Bruin (The Neteherlands) & H Meltzer (UK) Euro-reves: Setting up a coherent set of indicators Euro-reves participants

Functional limitations Vincent Coutton, France Jaap van den Berg, The Netherlands Jean-Marie Robine, France Carol Jagger, United Kingdom Euro-reves: Setting up a coherent set of indicators Euro-reves participants

Activity restrictions (a detailed approach) Emmanuelle Cambois, France Jean-Marie Robine, France Carol Jagger, United Kingdom Euro-reves: Setting up a coherent set of indicators Euro-reves participants

GALI: Global Limitation Indicator Rom Perenboom, The Netherlands Herman Van Oyen, Belgium Euro-reves: Setting up a coherent set of indicators Euro-reves participants

Health Perceptions Jeanette Nørlev, Denmark Niels Kr. Rasmussen, Denmark Rosa Gispert Magarolas, Spain Euro-reves: Setting up a coherent set of indicators Euro-reves participants

Mental health Karen Ritchie, France Michael Crawford, United Kingdom Euro-reves: Setting up a coherent set of indicators Euro-reves participants

A Method to Decompose Differences in Health Expectancy by Cause Wilma J Nusselder, The Netherlands Caspar WN Looman, The Netherlands Jan J Barendregt, The Netherlands Euro-reves: Setting up a coherent set of indicators Euro-reves participants